DQ2   (COMMENT 1). REFERENCES CITATION NO PLAGIO 150 WORDS Comparison the physical assessment of a child to that of an adult (focus should be on what you learned on completing childrens health assessments) Similarities: Past medical history, current medications, chief complaint, signs and symptoms (OLDCARTS), assessment of systems (neuro, HEENT, respiratory, cardiac, GI, GU, integumentary, musculoskeletal, pain, etc). Differences: Pain scales are very different, as adults generally use a 0-10 pain scale but children will benefit from a FACES scale or looking at behavioral or physical indicators of pain: grimacing, inconsolability, elevated heart rate, guarding (Andersen et al., 2019). For an accurate health history, parents will need to be included in the process; without surprise, generally this history will be much shorter than an adult history, unless the child was sickly. Parents may also need to be involved for supplemental information; in our simulation, the child could tell me the cough medicine was a certain color but it was his caregiver that told me what the actual medication was. Explanation of how the nurse would offer instruction (to children) during the assessment Children might not respond to the nurse instructing them during the assessment so a doll to puppet to show them what to expect might be helpful (Klossner & Hatfield, 2010). For example, listening to a doll with a stethoscope allows the child to see the stethoscope in use, where it will be touching on their body, and what the nurse will ask them to do while they listen; it might be helpful to let the child touch the stethoscope and listen to the nurse’s chest. With children, some instruction might have to come from the parents or parts of the assessment completed in the arms of the parents so the child feels secure. Adaption of communication for children of different ages Infants are easy, nurses will communicate mostly with the parent aside from some baby talk and smiling at the infant. With young children, communication should always be done at eye level, whether that is with the child on the exam table or the nurse sitting at the same level as the child, communication should be slow, clear, calm, and in terms that a child would understand (Klossner & Hatfield, 2010). As children get older, the nurse needs to explain exactly what they will be doing in the assessment, when they are doing it, what to expect and, allowing for questions and answers. Strategies to encourage children during the assessment As previously mentioned, a strategy to encourage children during an assessment would include a doll or via puppet might be helpful when communicating with a young child. Always allow children to ask questions and not rush them, they might ask “why” or “what” and require frequent answers and support (Klossner & Hatfield, 2010). Nielson and Reeves make recommendations for nursing care to include, “role-play, simulation, and drama” (2019). Role play would allow the child to wear the stethoscope and listen to the nurse’s or parent’s lungs; simulation would allow the child to see the assessment on the doll (or parent) first; and drama would be puppetry, having a puppet do the assessment or the teaching to the child.   Andersen, R.D., Nakstad, B., Jylli, L., Campbell-Yeo, M., & Anderzen-Carlsson, A. (2019). The complexities of nurses’ pain assessment in hospitalized preverbal children. Pain Management Nursing, 20(4), 337-334. Retrieved from https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S1524904218301747?via%3Dihub  Klossner, N.J., & Hatfield, N.T. (2010). Introductory Maternity & Pediatric Nursing. PA: Lippincott Williams & Wilkins. Neilson, S.J., & Reeves, A. (2019). The use of a theatre workshop in developing effective communication in paediatric end of life care, Nurse Education in Practice, 36, 7-12. Retrieved from https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S1471595318300763?via%3Dihub DQ2.  (COMMENT 2)   NO PLAGIO CITATION REFERENCES AND 150 WORDS There are significant physical and developmental differences between children and adults. Ideally, a physical assessment begins with subjective and objective data where observations and asking of questions are done in the adult population to fulfill the assessment part but in pediatric population, the care giver or parent is the historian in extraction of the required information. This applies to the toddlers and some preschoolers who are still afraid of strangers. In pediatrics, a nurse could have different patients of entirely different ages. As a nurse this means different reasoning strategies to convince them to take medications, different physical skills based on motor development, different coping abilities to painful or traumatic procedures, different cognitive abilities, different lab values and vital signs normal ranges and so on. This is the most challenging part of dealing with pediatrics – such a wide variety in developmental stages. When dealing with the adult population, majority of them fall within very consistently expected cognitive, physical, emotional and clinical data ranges. When approaching the pediatrics for explanation about a procedure that is to be done, then a nurse must have caution and use character play to convince them and make them understand. Pictures and diagrams come in handy in getting them to understand. One must take time to win their trust for them to accept and listen to you. This is like learning a different language all together. When discussing a procedure or diagnosis with an adult patient, the nurse uses logical explanations in helping to understand what they expect. This is where the family and relatives come in handy to help the patient understand because they are in distress and there learning capabilities are low. Dealing with both populations have its own pros and cons, there are tough moments where a nurse caring for adults may encounter temper tantrums, teenage mood swing, uncooperative adult patients and even abusive too and children ever crying until it becomes hard to handle them. Adults would always have more complicated medical histories unlike children. Quite several ailments may have interconnectedness hence need for a thorough history taking. This comes with histories of allergies and coming with a cocktail of different kinds of medications unlike pediatrics who have fewer or even none. Pediatrics while on care would always crash very easily because they have less reserves and can compensate normal vitals for extended periods before a sudden decline. Pediatrics won’t talk and this then calls for thorough and keen assessment skills and reliance on intuition. Children would always code starting with respiratory arrest unlike adults who in most cases start with cardiac arrest. Its easier discussing living will and medical decisions with an adult patient unlike in pediatrics where you discuss with the parents who are legally responsible. This can cause ethical dilemmas for nurses at times if a child disagrees with the treatment the guardian consents to.     References.     How are Children Different from Adults? | CDC (2019) retrieved from https://www.cdc.gov/childrenindisasters/differences.html   Falkner, A. (2018) Health Assessment: Foundations for Effective Practice retrieved from https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/health-assessment_foundations-for-effective-practice_1e.php

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Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation

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